The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.
Efficacy of PD-1 Blockade Is Potentiated by Metformin-Induced Reduction of Tumor Hypoxia
Open accessPublished version of a preprint
Abstract
Blockade of the coinhibitory checkpoint molecule PD-1 has emerged as an effective treatment for many cancers, resulting in remarkable responses. However, despite successes in the clinic, most patients do not respond to PD-1 blockade. Metabolic dysregulation is a common phenotype in cancer, but both patients and tumors are metabolically heterogeneous. We hypothesized that the deregulated oxidative energetics of tumor cells present a metabolic barrier to antitumor immunity through the generation of a hypoxic microenvironment and that normalization of tumor hypoxia might improve response to immunotherapy. We show that the murine tumor lines B16 and MC38 differed in their ability to consume oxygen and produce hypoxic environments, which correlated with their sensitivity to checkpoint blockade. Metformin, a broadly prescribed type II diabetes treatment, inhibited oxygen consumption in tumor cells in vitro and in vivo, resulting in reduced intratumoral hypoxia. Although metformin monotherapy had little therapeutic benefit in highly aggressive tumors, combination of metformin with PD-1 blockade resulted in improved intratumoral T-cell function and tumor clearance. Our data suggest tumor hypoxia acts as a barrier to immunotherapy and that remodeling the hypoxic tumor microenvironment has potential to convert patients resistant to immunotherapy into those that receive clinical benefit. Cancer Immunol Res; 5(1); 9–16. ©2016 AACR.
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“Current studies have focused on the role of hypoxia-induced metabolic reprogramming in causing T cell dysfunction and exhaustion16,19,52–55.”
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Cites
Immune Checkpoint Blockade: A Common Denominator Approach to Cancer Therapy
Topalian, S. L., Drake, C. G., & Pardoll, D. M. (2015) · Cancer Cell · doi:10.1016/j.ccell.2015.03.001 · Cited by 4,229 · cited 7×
“org Cancer Immunol Res; 5(1) January 2017 11”
BackgroundInfluentialGenomic and Transcriptomic Features of Response to Anti-PD-1 Therapy in Metastatic Melanoma
Hugo, W., Zaretsky, J. M., Sun, L., Song, C., Moreno, B. H., Hu-Lieskovan, S., Berent-Maoz, B., Pang, J., Chmielowski, B., Cherry, G., et al. (2016) · Cell · doi:10.1016/j.cell.2016.02.065 · Cited by 3,448
Metabolic Competition in the Tumor Microenvironment Is a Driver of Cancer Progression
Chang, C.-H., Qiu, J., O’Sullivan, D., Buck, M. D., Noguchi, T., Curtis, J. D., Chen, Q., Gindin, M., Gubin, M. M., van der Windt, G. J. W., et al. (2015) · Cell · doi:10.1016/j.cell.2015.08.016 · Cited by 3,331 · cited 2×
“can be metabolically plastic, and are primed to utilize glucose in oxygen-poor conditions, glucose, too, can be limiting in the tumor microenvironment (15,16).”
BackgroundMetformin and reduced risk of cancer in diabetic patients
Evans, J. M. M., Donnelly, L. A., Emslie-Smith, A. M., Alessi, D. R., & Morris, A. D. (2005) · BMJ · doi:10.1136/bmj.38415.708634.f7 · Cited by 2,388 · cited 1×
“It is established that patients taking metformin for type II diabetes have a decreased risk of cancer (17, 18) and that much of the antitumor metformin effect can be attributed to T cells (19).”
BackgroundPosttranscriptional Control of T Cell Effector Function by Aerobic Glycolysis
Chang, C.-H., Curtis, J. D., Maggi, L. B., Faubert, B., Villarino, A. V., O’Sullivan, D., Huang, S. C.-C., van der Windt, G. J. W., Blagih, J., Qiu, J., et al. (2013) · Cell · doi:10.1016/j.cell.2013.05.016 · Cited by 2,204
Woo, S.-R., Turnis, M. E., Goldberg, M. V., Bankoti, J., Selby, M., Nirschl, C. J., Bettini, M. L., Gravano, D. M., Vogel, P., Liu, C. L., et al. (2012) · Cancer Research · doi:10.1158/0008-5472.can-11-1620 · Cited by 1,647
Phosphoenolpyruvate Is a Metabolic Checkpoint of Anti-tumor T Cell Responses
Ho, P.-C., Bihuniak, J. D., Macintyre, A. N., Staron, M., Liu, X., Amezquita, R., Tsui, Y.-C., Cui, G., Micevic, G., Perales, J. C., et al. (2015) · Cell · doi:10.1016/j.cell.2015.08.012 · Cited by 1,462 · cited 2×
“However, in the tumor microenvironment, as glucose is limiting, only cells able to effectively compete for glucose would experience an enhanced response (15, 16).”
BackgroundScharping, N. E., Menk, A. V., Moreci, R. S., Whetstone, R. D., Dadey, R. E., Watkins, S. C., Ferris, R. L., & Delgoffe, G. M. (2016) · Immunity · doi:10.1016/j.immuni.2016.07.009 · Cited by 848
Self-citationAerobic glycolysis promotes T helper 1 cell differentiation through an epigenetic mechanism
Peng, M., Yin, N., Chhangawala, S., Xu, K., Leslie, C. S., & Li, M. O. (2016) · Science · doi:10.1126/science.aaf6284 · Cited by 787 · cited 1×
“to effector function epigenetically and post-transcriptionally (26-28).”
Scharping, N. E., Menk, A. V., Moreci, R. S., Whetstone, R. D., Dadey, R., Watkins, S. C., Ferris, R. L., & Delgoffe, G. M. (2016) · Immunity · doi:10.1016/j.immuni.2016.08.009 · Cited by 708 · cited 1×
“We have previously shown that T cells in the tumor microenvironment are at a metabolic disadvantage and repress oxidative metabolism (13).”
BackgroundSelf-citation
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Chen, Y.-F., Yu, Z., Lv, M., Cai, Z.-R., Zou, Y.-F., Lan, P., Wu, X.-J., & Gao, F. (2021) · Figshare · doi:10.6084/m9.figshare.16909936
Chen, Y.-F., Yu, Z., Lv, M., Cai, Z.-R., Zou, Y.-F., Lan, P., Wu, X.-J., & Gao, F. (2021) · Figshare · doi:10.6084/m9.figshare.16909930
Wang, H., Nan, L., Zheng, Y., Guo, J., & Piao, G. (2025) · Chinese Chemical Letters · doi:10.1016/j.cclet.2025.111837
Shaping cell therapy manufacturing with metabolic understanding and control
Costa, C. M., Terrasso, A. P., Costa, M. H. G., Alves, P. M., & Serra, M. (2026) · Trends in biotechnology · doi:10.1016/j.tibtech.2026.03.006
Role of co-activating receptors CD226 and CD137 in T cell exhaustion
Pichler, A. (2020) · theses.fr (ABES) · doi:10.70675/ec9fb2bazf7a9z4305z9a58zb5cbc6e74e63
Impact du ciblage du domaine de liaison de HIF-1α avec HIF-1β sur le paysage immunitaire du mélanome
Lequeux, A. (2020) · theses.fr (ABES) · doi:10.70675/a29d12dbz79c1z4d37za978z2e2319131c82
EVT-701 : targeting electron transport chain complex I as therapeutic approach in cancer
Yolba, R. L. (2021) · theses.fr (ABES) · doi:10.70675/9cadea77z03ccz4a54zb381zf34a432615a5
Yu, Z., Lu, X. L., Pi, R., Zhang, X., Jian, H., Lin, X., Wang, W., & Bai, X. (2026) · Frontiers in Bioscience-Landmark · doi:10.31083/fbl49071
Bhongade, B. A., Ali, A. A., El‐Tanani, M., Satyam, S. M., Talath, S., Wali, A. F., Rabbani, S. A., Ibraheem, W., Hoffmann, K., Арманович, А. А., et al. (2026) · Current Issues in Molecular Biology · doi:10.3390/cimb48070723
“Drug repurposing with agents such as metformin, statins and FAS inhibitors provides an opportunity to fast-track clinical translation; however, oncology-specific dosing may contrast with indications for these agents on metabolic indication [89,102,107].”
Guedes, J., Woldmar, N., Baltás, E., Kriston, A., Migh, E., Kovács, F., Oskolás, H., Marko-Varga, M., Appelqvist, R., Wieslander, E., et al. (2026) · npj Precision Oncology · doi:10.1038/s41698-026-01569-w · Cited by 1
“Preclinical and clinical evidence suggest that adding metformin can enhance the ef fi cacy of immune and targeted therapies, possibly by hampering tumor metabolic adaptation and alleviating therapy-induced tumor hypoxia 22,23 .”
Asl, K. D., Kalarestaghi, H., Rafat, A., Bahramloo, M., Shahabi, S. A., Mollayousefi, H. S., Moosavi, S. S., & Mazloumi, Z. (2026) · Molecular Biology Reports · doi:10.1007/s11033-026-12519-x
“In addition, metformin may support memory T-cell differentiation and survival through the AMPK-miR-107-Eomes axis and by modulating PD-1 expression [107, 112 ].”
Teiama, M. S. A., Gohar, A., Amr, M., El‐Shinawi, M., & Elkhatib, W. F. (2026) · Molecular Biomedicine · doi:10.1186/s43556-026-00534-0
“Also, Scharping group studies revealed that utilizing oxygen with metformin corrected hypoxic TME conditions, improved T-lymphocyte activity, and enhanced the enhanced the efficacy of PD-1 immunotherapy [176].”
Mitochondrial transfer: a new perspective on tumor-microenvironment crosstalk driving metastasis
Duan, Y., Li, A., Hu, X., Xiong, Z., Shi, J., & Wang, K. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1922061
“…bene fi ts in animal models: on the one hand, it reduces tumor oxygen consumption and alleviates microenvironmental hypoxia by inhibiting the mitochondrial complex I in cancer cells; on the other hand, it enhances antitumor immunity by activating AMP-activated protein kinase in T cells (90, 91).”
Li, M., Zhang, Y., Shen, K., Hou, K., An, S., Zhang, Y., Yang, L., & Ma, J. (2026) · Cancer Treatment and Research Communications · doi:10.1016/j.ctarc.2026.101373
Mitochondria as central regulators of cancer progression and antitumor immunity
Gómez-Durán, A., & Martínez‐Reyes, I. (2026) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2026.07.005
Biomarker discovery and validation in inflammatory cancer research
Guan, X. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-36649-9.00002-5
Perin, M., Lipani, A., Loffa, M., Todesco, A. M., Kopecka, J., & Riganti, C. (2026) · Biomolecules · doi:10.3390/biom16101422
“For instance, metformin has been shown to improve the efficacy of immune check-point inhibitors by limiting mitochondrial oxygen consumption [86]: this relieves the immune suppression characterizing a hypoxic TME [87].”
Azad, A., Carter, R., Wu, Y., Thavaraj, S., Vasiliadou, I., Mustafa, R., Ng, T., Kalber, T. L., & Kong, A. H. (2026) · Cancer Letters · doi:10.1016/j.canlet.2026.218894
Sanders, J., Hahn, N., Bos, E. N., van Schie, D. M., Nijman, I. J., van Grieken, N. C. T., van der Peet, D. L., van Laarhoven, H. W. M., Grootjans, J., Bijlsma, M. F., et al. (2026) · British Journal of Cancer · doi:10.1038/s41416-026-03635-3
Wang, Y., Liu, M., & Zhong, L. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1991297
Metadata
- Authors
- Scharping, N. E., Menk, A. V., Whetstone, R. D., Zeng, X., & Delgoffe, G. M.
- Affiliations
- University of Pittsburgh (US)
- UPMC Hillman Cancer Center (US)
- Corresponding author
- Delgoffe, Greg M.
- Venue
- Cancer Immunology Research
- Published
- 2017-01-01
- Volume
- 5
- Issue
- 1
- Pages
- 9-16
- ISSN
- 2326-6066 (ISSN-L)
- 2326-6074
- PMC
- PMC5340074
- OpenAlex
- W2560185130
- Cited by
- 520
- References
- 30
- Citations by year
- 2026: 34 · 2025: 53 · 2024: 49 · 2023: 72 · 2022: 85 · 2021: 79 · 2020: 69 · 2019: 38 · 2018: 30 · 2017: 11
- FWCI
- 14.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer Immunology Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- UPCI (P30CA047904)
- Sidney Kimmel Foundation for Cancer Research (SKF-015-039)
- University of Pittsburgh Cancer Institute Skin Cancer (P50CA121973-08)
- University of Pittsburgh Cancer Institute Head and Neck Cancer SPORE (P50 CA097190)
- Cancer-AACR Innovative Research (SU2C-AACR-IRG-04-16)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- anti-PD-1 therapy, metformin, tumor hypoxia, tumor microenvironment, cancer immunotherapy resistance, combination therapy, oxidative metabolism, T cell function, B16 melanoma, MC38 colon carcinoma, antitumor immunity
- MeSH terms
- Tumor Hypoxia, Antineoplastic Agents, Immunological, Animals, Cytotoxicity, Immunologic, Drug Synergism, Energy Metabolism, Melanoma, Experimental, Metformin, Oxygen Consumption, T-Lymphocytes, Cytokines, Lymphocytes, Tumor-Infiltrating, Mice, Tumor Microenvironment, Programmed Cell Death 1 Receptor
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